Perceived preparedness to provide preventive counseling

OBJECTIVE: To assess the perceived preparedness of residents in adult primary care specialties to counsel patients about preventive care and psychosocial issues. DESIGN: Cross-sectional national mail survey of residents (63% response rate). PARTICIPANTS: Nine hundred twenty-eight final-year primary care residents in Internal Medicine (IM), family practice (FP), and Obstetrics/Gynecology (OB/GYN) at 162 U.S. academic health centers. MEASUREMENTS: Residents self-rated preparedness to counsel patients about smoking, diet and exercise, substance abuse, domestic violence, and depression. RESULTS: Residents felt better prepared to counsel about smoking (62%) and diet and exercise (53%) than about depression (37%), substance abuse (36%), or domestic violence (21%). In most areas, females felt better prepared than males. Rates of counseling preparedness varied significantly by specialty after adjustment for gender, race, medical school location, and percent of training spent in ambulatory settings. FP residents felt better prepared than OB/GYN residents to counsel about smoking, diet and exercise, and depression, while OB/GYN residents felt better prepared to address domestic violence than IM or FP residents. IM residents' perceptions of preparedness were between the other 2 specialties. Proportion of training spent in ambulatory settings was not associated with residents' perceived preparedness. CONCLUSIONS: Physicians completing residencies in adult primary care did not feel very well prepared to counsel patients about preventive and psychosocial issues. Significant differences exist among specialties, even after adjusting for differences in time spent in ambulatory settings. Increasing residency time in ambulatory settings may not alone be sufficient to ensure that residents emerge with adequate counseling skills.     

Perceived youth: appraisal and characterization

Results from a mail survey of respondents aged sixty to ninety-four suggest that psychographic dimensions of youthfulness and identification with old age constitute effective inner-age research variables, especially to those seeking to study older populations. The two specific dimensions explored are: "perceived youth," a magnitude measure of the proportional discrepancy between chronological and cognitive ages; and "feeling-old," which inversely measured youth through reliance on a six-point Likert agree/disagree statement: "I feel old...." In addition to the obvious inverse relationship between these inner-ages, research established trait covariation relative to an increase in perceived youth coincidental with a rejection of a feeling-old identity, corresponding to increases in "happiness, own-health rating, being venturesome, giving advice, self-esteem, social activity, and keeping-in-shape," as well as decreases in "taking advice, being a homebody, and having health worries."     

Perceived work environment and cognitive style

Differences in perceived work environment are examined by age, gender, and occupation type, along with whether cognitive style predicts perceived work environment. The sample consists of 2185 men and women ranging in age from 21 to 93 years. Perceived work environment was measured using Moos's Work Environment Scale (WES) for the subscales of Autonomy, Control, and Innovation. The Test of Behavioral Rigidity (TBR) was used to measure cognitive style. Findings indicate significant mean level differences in perceived work environment based on gender, age, and occupation type. Hierarchical regression analyses indicated that perceived work environment predicted concurrent cognitive style beyond demographic variables.     

Perceived parental style and eating psychopathology

Women with anorexic and bulimic disorders perceive their family interaction as ‘unhealthy’. However, this pattern is common to a variety of psychological disorders. Are there more specific patterns of perceived family functioning that might be associated with the psychopathology of eating disorders? This paper describes the construction and clinical validation of a Parental Style Questionnaire, measuring perceived parental disapproval and setting of standards. Women with eating disorders generally described their parents as disapproving. Anorexics saw their mothers in particular as setting abnormally high standards, while bulimics reported abnormally low standards. It is suggested that both groups experience parental disapproval as aversive and uncontrollable, and that either pattern could maintain the poor self-esteem that is central to eating disorders. The potential uses and limitations of the PSQ as a clinical and research measure are discussed.     

Perceived parenting ability and systemic sclerosis

Objective. The purpose of this study was to compare perceived parenting abilities in mothers with systemic sclerosis (SSc) based on the subtype of SSc and age group of their children, and to examine how the degree of pain, fatigue and functional ability relates to parenting ability. Methods. In this cross‐sectional survey, 74 mothers with SSc, who had children aged 18 years or younger living at home with them, completed a series of questionnaires online or on paper. The questionnaires included the Parent Disability Index (PDI) and surveys regarding demographic information, pain (visual analogue scale), fatigue (Multidimensional Assessment of Fatigue) and functional ability (Health Assessment Questionnaire). Results. An analysis of variance revealed that the mean age of the mother (F_2,71 = 7.9; p < 0.01), mean PDI score (F_2,68 = 5.4; p < 0.01) and mean pain score (F_2,71 = 4.0; p = 0.02) were each associated with the age group of the children. The univariate analysis of variance results showed that dichotomized pain (F_1,69 = 13.3; p < 0.01), fatigue (F_1,69 = 18.9; p < 0.01) and disability (F_1,69 = 9.8; p < 0.01) were each associated with the PDI score. The multivariate analysis of variance results showed that dichotomized pain (F_1,68 = 7.5; p < 0.01) and fatigue (F_1,68 = 12.7; p < 0.01) were associated with the PDI. Conclusion. Mothers with SSc report difficulty with parenting, which can be related to the severity of the symptoms. The findings suggest that interventions to reduce pain and fatigue may improve perceived parenting ability. Copyright © 2010 John Wiley & Sons, Ltd.     

Perceived health status in celiac disease.

INTRODUCTION: Chronic conditions modify perceived health in affected individuals. For this reason celiac disease, being a chronic condition, may impair health-related quality of life (HRQOL). OBJECTIVE: To analyze the impact of celiac disease in affected individuals. METHOD: Observational, cross-sectional, prospective study in patients with celiac disease by administering two HRQOL questionnaires: EuroQol-5D and GastroIntestinal Quality of Life (GIQLI). RESULTS: 54 stable patients on a gluten-free diet for a median 60 months, and 9 newly diagnosed individuals still on their usual diet were included. Overall GIQLI score was significantly higher, meaning a better HRQOL, in treated celiac patients versus pre-treated celiac patients (3.1 [2.7-3.5] vs. 2.4 [2.1-2.6], p < 0.01). Similarly, EuroQol s health status preference value was also significantly better in treated patients (0.87[0.8-1.0] vs. 0.7 [0.5-0.8], p < 0.01). EuroQol s visual analogic scale had also better scores, representing a better perceived health, among treated patients (80.0 [70.0-90.0] vs. 65.0 [40.0-71.0], p < 0.05). In comparison to EuroQol-5D scores among the healthy Spanish population, values obtained for celiac patients under treatment are similar to those seen in the general population. CONCLUSIONS: celiac disease impairs perceived health in affected individuals, which improves and reaches results similar to those in the general population when on a gluten-free diet.     

Perceived Leisure Functioning of Nursing Home Patients

The purpose of this study was to determine the effect of an organized recreation program on the perceived leisure functioning of six elderly, mentally ill patients living in a nursing home. The Comprehensive Leisure Rating Scale (CLEIRS) was used as the assessment instrument. The CLEIRS was completed by a licensed practical nurse who observed the subjects prior to implementation of an organized recreation program and two times during the recreation rogram. Results indicated that one patient improved in perceived reisure functioning, one patient decreased in perceived leisure functioning, one patient showed mixed results, and three patients remained the same in their perceived leisure functioning.     

Perceived injustice in fibromyalgia and rheumatoid arthritis

This is a pilot study to compare levels of perceived injustice via the Injustice Experience Questionnaire in patients with fibromyalgia or rheumatoid arthritis. Two cohorts of patients, one with fibromyalgia (FM), one with rheumatoid arthritis (RA), completed the Injustice Experience Questionnaire, a visual analogue pain scale, and the Hospital Anxiety and Depression Scale (HADS). Inferential statistics were then used to determine whether participants in the two diagnostic groups had significantly different scores on the Perceived Injustice Questionnaire. This was done univariately using t tests and after adjusting for potential confounders using ANCOVA. We also examined crude associations between the variables using Pearson correlation coefficients, then examined the adjusted association between diagnostic group and perceived injustice using multivariable linear regression. Our final models were built in a blocked fashion by initially entering diagnostic category into the model, then entering other variables simultaneously using a stepwise strategy (p-to-enter ≤.05, p-to-remove ≥.10). A total of 126 participants (64 FM, 62 RA) completed all questionnaires. The FM group had a greater percentage of female participants, more severe pain, more severe anxiety and more severe depression. In unadjusted analysis, the FM group had higher Injustice Experience Questionnaire scores. When the RA and FM group scores for the Injustice Experience Questionnaire are adjusted for pain levels, there is no statistically significant difference between groups. Adjustment for HADS anxiety and HADS depression does not significantly affect the Injustice Experience Questionnaire scores after adjustment for pain. Fibromyalgia is associated with a higher level of perceived injustice than is seen with rheumatoid arthritis. This difference appears to be associated with higher levels of pain reported by fibromyalgia patients, and therefore may not be specific to the diagnosis. Prospective studies may help to resolve this issue.     

Perceived functional disabilities among rheumatoid arthritis patients

The aim of this study was to determine from patient perspective the most relevant physical functions when estimating the functional disabilities, and to estimate the perceived relative influence of them. Structured telephone interviews were conducted among 143 RA patients. The subjects were asked to name functions and activities in their everyday life, which were affected by RA. After this, they were asked to score each of the named item with a scale from 0 to 100. These were combined with earlier collected data on sociodemographic background and clinical status. Listed activities were grouped to functional disabilities and further categorized according to joints, limbs and body areas. One or more functional disabilities affecting everyday life because of RA was mentioned by 87.4%, altogether 354 mentions. The most commonly mentioned disabilities were walking and opening jars. However, the most commonly mentioned disabilities were not those with highest perceived disabilities. Of the 59 different types of disabilities mentioned, 25 were connected with movements of the shoulder, 30 with elbow, 40 with wrist, and 37 with fingers. Movements of the back were involved in 20 mentioned disabilities, hip and knee both in 8, and ankles in 6. Disabilities related to lower extremity functions were considered most disabling. In conclusion, to describe RA patients’ functional disability, the measured functions should be those which the patients themselves consider relevant and causing disability. Furthermore, the studied functional measures ought to be weighted according to the relative influence of each function to the patients.     

Perceived Condom Use Self-Efficacy Among At-Risk Women

The objectives of this study are to assess the confidence in their ability to use condoms among at-risk women and identify predictors for the women's condom use self-efficacy. Structured interviews were conducted with 250 adult women in Atlanta, Georgia, between August 1997 and August 2000. Overall, the women reported feeling moderately to moderately–strongly confident in their ability to use condoms consistently. Multivariate analysis showed women with higher condom use self-efficacy were significantly younger, experienced childhood neglect, had higher self-esteem, communicated better with their sex partner, and had fewer drug problems. Findings suggest the importance of addressing condom use self-efficacy in HIV risk reduction programs with a specific focus on women and the need to be attuned to tailored needs for specific subgroups such as older women or women who encountered childhood neglect.     

Perceived Competence and Physical Activity in Older Adults

The association between older adults’ self-perceived physical competence and continued involvement in physical activity (PA) was examined. Seventy-two older adults (60–79 years) completed the Physical Self Perception Profile (PSPP; Fox and Corbin, 1989) and International Physical Activity Questionnaire to assess the relationship between physical self-perception and various dose responses in PA participation (vigorous, moderate, walking, inactive/sitting levels). Results indicated a positive correlation between all subscales of the PSPP and both moderate exercise and vigorous exercise. In addition, Sport, Body, and Strength were positively correlated with walking. Age (60–69 vs. 70–79 years) and gender, however, were found to modify those relationships. Mann Whitney University tests revealed that participants in the younger grouping were significantly more likely to spend a greater amount of time walking than those in the older adult grouping. Moreover, males were significantly more likely to participate in vigorous exercise and reported a higher perception of sports competence than their female counterparts. The results of this study suggest that perceived competence be assessed during pre-exercise screening in order to customize exercise programs that will increase the likelihood of continued PA engagement.     

Consequences of Perceived Stigma Among Patients with Cirrhosis

Background

Among patients with diseases such as HIV, cancer and mental illness, perceived stigma is common and is linked to quality of life (QOL), depression and healthcare-seeking behavior.

Aims

We aimed to determine the prevalence and consequences of stigma in patients with cirrhosis.

Methods

A survey was developed and mailed to 300 patients with cirrhosis from a variety of etiologies. Among the 149 respondents, stigma was measured using a composite of previously validated scales. Correlates of stigma were measured using an a priori theoretical construct in order to investigate hypothesized consequences such as impaired social support, depression and reduction in healthcare-seeking behavior.

Results

Eighty-nine percent of respondents chose “agree” or “strongly agree” for at least one of the 18 stigma-related questions, indicating they felt stigmatized in at least one aspect of their lives. Patient factors associated with more perceived stigma on multivariable linear regression included younger age (p = 0.008), and hepatitis C (p = 0.001) or alcohol (p = 0.01) as the etiology of liver disease. Patients with higher levels of perceived stigma had less social support (r ² = 0.898, p < 0.001), were less likely to seek medical care (r ² = 0.108, p < 0.001), suffered from more depression (r ² = 0.17 p < 0.001) and had worse QOL (r ² = 0.175, p < 0.001).

Conclusions

Perceived stigma is common among patients with cirrhosis, and is associated with adverse attitudes and behaviors such as decreased healthcare-seeking behavior. Healthcare providers need to be aware of these perceptions and their potential impact on patients’ interaction with the medical system.     

Perceived personal deadlines for late-life preparation across adulthood

Throughout adulthood, individuals follow personal timetables of deadlines that shape the course of aging. We examine 6-year-longitudinal data of perceived personal deadlines for starting with late-life preparation across adulthood. Findings are based on a sample of 518 adults between 18 and 88 years of age. Multilevel regression analyses were conducted to explore changes in personal deadlines for preparation in five domains (i.e., finances, end of life, housing, social connectedness, caregiving) in relation to calendar age, self-rated health, subjective position in life, and sociodemographic variables. Findings suggest that personal deadlines for starting preparatory activities differ depending on calendar age and domain of late-life preparation. Older adults as compared to younger adults are likely to report narrower deadlines for beginning with late-life preparation. Perceived deadlines for late-life preparation were furthermore found to be preponed and slightly dilated over time. Findings suggest that depending on age-graded opportunity structures, individuals flexibly adjust their personal deadlines for late-life preparation.Electronic supplementary materialThe online version of this article (10.1007/s10433-020-00581-8) contains supplementary material, which is available to authorized users.     

Perceived strategies and activities for successful later aging

This study investigated perceived strategies and activities for successful later aging. Participants were 242 members of the Terman Study of the Gifted who responded to an open-ended question concerning how they make the most of their aging years. Data were collected in 1996 and 1999, when the participants were average ages of 84 and 86. Longitudinal analyses examined changes over time and cross-sectional analyses examined correlates of strategies and activities. Results showed that strategies emphasized emotion regulation and adaptation. Activities emphasized family involvement, social relationships, leisure, productive and intellectual activity, and health maintenance. Reports of emotion regulation and adaptation increased over time and mention of an intellectual orientation declined over time. Variations in activity mention were found according to gender, age, self-rated health, health limitations, and life satisfaction. History of higher-level occupations was related to more productive activities. Results are discussed in terms of the challenges of later aging.     

Perceived health problems in elderly residents of Jordan

Jordan is typical of many developing countries in that the improving health services have significantly reduced child and infant mortality. A high fertility rate coupled with this reduction in mortality has increased the numbers of those living to adulthood and into old age. This paper identifies, in broad terms, areas where service delivery might be considered for implementation thereby improving the well-being in the elderly person. 965 residents of Jordan 55 to 95 years of age were sampled from Amman, Irbid and the surrounding suburbs. All subjects were designated, from a medical examination, as having or not having a chronic illness. Student's t-test comparing the Jordan subjects' mean scores on the six dimensions of the NHP with previously reported data suggested that although the instrument was faithfully translated there might exist significant cultural differences. Similarly, differences between males and females suggested a possible gender bias in the interpretation of the items. All chronically ill subject groupings had higher (poorer) mean scores on all dimensions. Healthy elderly males and females have a better perceived well-being than their chronically ill counterparts.     

Perceived discrimination and use of preventive health services

BACKGROUND: Little is known about the relation between perceptions of health care discrimination and use of health services. OBJECTIVES: To determine the prevalence of perceived discrimination in health care, its association with use of preventive services, and the contribution of perceived discrimination to disparities in these services by race/ethnicity, gender, and insurance status. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 54,968 respondents to the 2001 California Health Interview Survey. MEASUREMENTS: Subjects were asked about experience with discrimination in receiving health care and use of 6 preventive health services, all within the previous 12 months. METHODS: We used multivariate logistic regression with propensity-score methods to examine the adjusted relationship between perceived discrimination and receipt of preventive care. RESULTS: Discrimination was reported by 4.7% of respondents, and among these respondents the most commonly reported reasons were related to type of insurance (27.6%), race or ethnicity (13.7%), and income (6.7%). In adjusted analyses, persons who reported discrimination were less likely to receive 4 preventive services (cholesterol testing for cardiovascular disease, hemoglobin A1c testing and eye exams for diabetes, and flu shots), but not 2 other services (aspirin for cardiovascular disease, prostate specific antigen testing). Adjusting for perceived discrimination did not significantly change the relative likelihood of receipt of preventive care by race/ethnicity, gender, and insurance status. CONCLUSIONS: Persons who report discrimination may be less likely to receive some preventive health services. However, perceived discrimination is unlikely to account for a large portion of observed disparities in receipt of preventive care.     

Association of Perceived Stress With Incident Heart Failure

BackgroundThe relationship between psychological stress and heart failure (HF) has not been well studied. We sought to assess the relationship between perceived stress and incident HF.MethodsWe used data from the national REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a large prospective biracial cohort study that enrolled community-dwellers aged 45 years and older between 2003 and 2007, with follow-up. We included participants free of suspected prevalent HF who completed the Cohen 4-item Perceived Stress Scale (PSS-4). Our outcome variables were incident HF event, HF with reduced ejection fraction events, and HF with preserved ejection fraction events. We estimated Cox proportional hazard models to determine if PSS-4 quartiles were independently associated with incident HF events, adjusting for sociodemographics, social support, unhealthy behaviors, comorbid conditions, and physiologic parameters. We also tested interactions by baseline statin use, given its anti-inflammatory properties.ResultsAmong 25,785 participants with a mean age of 64 ± 9.3 years, 55% were female and 40% were Black. Over a median follow-up of 10.1 years, 1109 ± 4.3% experienced an incident HF event. In fully adjusted models, the PSS-4 was not associated with HF or HF with reduced ejection fraction. However, PSS-4 quartiles 2–4 (compared with the lowest quartile) were associated with incident HF with preserved ejection fraction (Q2 hazard ratio 1.37, 95% confidence interval 1.00–1.88; Q3 hazard ratio 1.42, 95% confidence interval 1.03–1.95; Q4 hazard ratio 1.41, 95% confidence interval 1.04–1.92). Notably, this association was attenuated among participants who took a statin at baseline (P for interaction = .07).ConclusionsElevated perceived stress was associated with incident HF with preserved ejection fraction but not HF with reduced ejection fraction.